USCIS
Supplement B, U Nonimmigrant Status Certification
Form I-918
Department of Homeland Security
OMB No. 1615-0104
U.S. Citizenship and Immigration Services
Expires 02/28/2019
Remarks
For
USCIS
Use
Only
START HERE - Type or print in black or blue ink.
►
Name of Head of Certifying Agency
Part 1. Victim Information
4.a. Family Name
1.
Alien Registration Number (A-Number) (if any)
(Last Name)
A-
►
4.b. Given Name
(First Name)
2.a. Family Name
(Last Name)
4.c. Middle Name
2.b. Given Name
(First Name)
Agency Address
2.c. Middle Name
5.a.
Street Number
and Name
Other Names Used (Include maiden names, nicknames, and
aliases, if applicable.)
5.b.
Apt.
Ste.
Flr.
If you need extra space to provide additional names, use the
5.c.
City or Town
space provided in Part 7. Additional Information.
3.a. Family Name
5.d.
State
5.f.
ZIP Code
(Last Name)
3.b. Given Name
5.g.
Province
(First Name)
3.c. Middle Name
5.h.
Postal Code
5.i.
Country
4.
Date of Birth (mm/dd/yyyy)
5.
Gender
Male
Female
Other Agency Information
Part 2. Agency Information
6.
Agency Type
Federal
State
Local
1.
Name of Certifying Agency
7.
Case Status
On-going
Completed
Name of Certifying Official
Other
2.a. Family Name
(Last Name)
8.
Certifying Agency Category
2.b. Given Name
(First Name)
Judge
Law Enforcement
Prosecutor
2.c. Middle Name
Other
3.
Title and Division/Office of Certifying Official
9.
Case Number
10.
FBI Number or SID Number (if applicable)
Form I-918 Supplement B 02/07/17 N
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